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Please list a personal reference and their relationship to you:

Your Home

If not a homeowner, do you have the landlord’s permission to have a pet?

Yes
No

List Your Current Pets

1.

Current Pet’s Name

Type of animal

Approximate Age

Sex:

Male
Female

Spayed/Neutered

Yes
No

Where did you obtain this pet?

How many years did you have this pet?

2.

Current Pet’s Name

Type of animal

Approximate Age

Sex:

Male
Female

Spayed/Neutered

Yes
No

Where did you obtain this pet?

How many years have you had this pet?

List Your Previous Pets

1.

Previous Pet’s Name

Type of animal

Approximate Age

Sex:

Male
Female

Spayed/Neutered

Yes
No

Where did you obtain this pet?

How many years did you have this pet?

What happened to this pet?

2.

Previous Pet’s Name

Type of animal

Approximate Age

Sex:

Male
Female

Spayed/Neutered

Yes
No

Where did you obtain this pet?

How many years did you have this pet?

What happened to this pet?

Family Vet Name:

Family Vet Phone:

Your New Pet

How many hours per day would the pet be left alone?

Can you guarantee that the pet will be kept indoors at all times?

When you travel, who will care for the pet while you are gone?

Under what circumstances would you not keep the pet?

DivorceIllness in familyMovingNew babyChewingHousetraining problemDiggingAllergiesGrew too bigShedding too muchPet illKids ignored petPets didn’t get alongNot obedient enoughWould not give up for any of the aboveOther

If other reason, why?

If the pet becomes ill or injured, are you financially prepared to provide the medical care?

YesNo

Do you intend to declaw the cat?

YesNo

The pet may live 15+ years, what would you do with your pet if you could no longer care for it?

How did you first hear about us?

Is there anything else you would like to tell us about yourself?

Questionnaire Information: All of the information I have provided is true and correct.

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